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Management of primary achalasia: The role of endoscopy

World Journal of Gastrointestinal Endoscopy 2015年第6期7卷 593-605页

作者： Marisol Luján-Sanchis Patricia Suárez-Callol Ana Monzá-Gallego Inmaculada Bort-Pérez Lydia Plana-Campos Luis Ferrer-Barceló Laura Sanchis-Artero María Llinares-Lloret Juan Antonio Tuset-Ruiz Javier Sempere-Garcia-Argüelles pilar canelles-gamir Enrique Medina-Chuliá Digestive Diseases Unit General University Hospital of Valencia

Achalasia is an oesophageal motor disorder which leads to the functional obstruction of the lower oesophageal sphincter(LES) and is currently incurable. The main objective of all existing therapies is to achieve a reduction in the obstruction of the distal oesophagus in order to improve oesophageal transit, relieve the symptomatology, and prevent long-term complications. The most common treatments used are pneumatic dilation(PD) and laparoscopic Heller myotomy, which involves partial fundoplication with comparable shortterm success rates. The most economic non-surgical therapy is PD, with botulinum toxin injections reserved for patients with a higher surgical risk for whom the former treatment option is unsuitable. A new technology is peroral endoscopic myotomy, postulated as a possible non-invasive alternative to surgical myotomy. Other endoluminal treatments subject to research more recently include injecting ethanolamine into the LES and using a temporary self-expanding metallic stent. At present, there is not enough evidence permitting a routine recommendation of any of these three novel methods. Patients must undergo follow-up after treatment to guarantee that their symptoms are under control and to prevent complications. Most experts are in favour of some form of endoscopic follow-up, however no established guidelines exist in this respect. The prognosis for patients with achalasia is good, although a recurrence after treatment using any method requires new treatment.

关键词： Achalasia Endoscopic treatment Dilation Botulinum toxin Myotomy

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